Clinical outcomes of different approaches to aortic arch disease

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Presentation transcript:

Clinical outcomes of different approaches to aortic arch disease Arudo Hiraoka, MD, Genta Chikazawa, MD, PhD, Kentaro Tamura, MD, Toshinori Totsugawa, MD, PhD, Taichi Sakaguchi, MD, PhD, Hidenori Yoshitaka, MD, PhD Journal of Vascular Surgery Volume 61, Issue 1, Pages 88-95 (January 2015) DOI: 10.1016/j.jvs.2014.06.121 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 A, One debranching with thoracic endovascular aortic repair (TEVAR). B, Two debranching with TEVAR. C, Total debranching with TEVAR. D, Staged TEVAR after open total aortic arch repair with elephant trunk (TARET). Journal of Vascular Surgery 2015 61, 88-95DOI: (10.1016/j.jvs.2014.06.121) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Kaplan-Meier survival based on the respective approach to aortic arch diseases in all patients. There was a significant difference in midterm outcome among the three groups (P < .001). The 3-year survival rate was 63.9% in the debranching with thoracic endovascular aortic repair (DTEVAR; dash-dot line) group, the 7-year survival rate was 90.1% in the conventional open total aortic arch repair (CTAR; solid line) group, and the 2.5-year survival rate was 95.5% in the staged TEVAR after TAR with elephant trunk (TARET+TEVAR; dashed line) group. B, Kaplan-Meier survival, based on the respective approach in elective cases (excluding emergency cases), found there was a significant difference in the midterm outcomes of elective operation among the three groups (P = .001). Journal of Vascular Surgery 2015 61, 88-95DOI: (10.1016/j.jvs.2014.06.121) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 Kaplan-Meier survival based on proximal landing zone in the debranching with thoracic endovascular aortic repair (DTEVAR) group. An increased number of debranching grafts led a lower follow-up survival rate (P = .008). Journal of Vascular Surgery 2015 61, 88-95DOI: (10.1016/j.jvs.2014.06.121) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 4 Kaplan-Meier survival based on emergency (dashed lines) vs elective (solid lines) operation in (A) debranching with thoracic endovascular aortic repair (DTEVAR) group (P = .059) and (B) in the conventional open total aortic arch repair (CTAR) group (P = .097). Journal of Vascular Surgery 2015 61, 88-95DOI: (10.1016/j.jvs.2014.06.121) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 5 Kaplan-Meier survival based on positive (solid line) and negative (dashed line) atherosclerotic (Athelo) change in (A) the debranching with thoracic endovascular aortic repair (DTEVAR) group (P = .045) and in (B) the conventional open total aortic arch repair (CTAR) group (P = .002). Journal of Vascular Surgery 2015 61, 88-95DOI: (10.1016/j.jvs.2014.06.121) Copyright © 2015 Society for Vascular Surgery Terms and Conditions